MSK Pediatric Orthopedic Conditions Flashcards
Thigh-foot angle
How to measure/what is it
Angle between axis of foot and axis of thigh measured with child prone and knees at 90 flexion —> describes degrees of TIBIAL torsion
3 causes of toeing-in
Metatarsus adductus
Internal tibial torsion
Increased femoral anteversion
What is metatarsus adductus, what are the 2 types
most common congenital foot deformity
1) rigid: medial subluxation of TMT it’s hindfoot slightly in valgus, navicular lateral to head of talus
2) flexible: adduction of all 5 metatarsals at TMT joint
What is surgical option for flexible metatarsus adductus
Release of abductor hallucinations tendon
Femoral anteversion is excessive if (degrees)
> 25 from frontal plane
Femoral retroversion is excessive if (degrees)
<10 from frontal plane
Toeing out is caused by
Femoral retroversion, external tibial torsion, flat feet
Talipes equinovarus (aka \_\_\_\_) occurs from what? What does deformity look like?
Clubfoot- postural rom intrauterine malposition
Abnormal dev of talar head/neck
Observation: PF, addicted, inverted foot (postural)
PT Tx for postural talipes equinovarus
- manipulation followed by casting/splinting (Ponseti method)
- following casting, stretching
- Denis-Browne splint orthoses throughout day for 3 months, at night up to 3 years
Tx for Talipes equinovarus NON-postural
Surgical intervention followed by casting/splinting
Achilles tenotomy may be needed
Genu ___ is normal in newborn and infants
Varum
Maximal varum present at ____ (age)
6-12 months
Lower limbs begin to straighten with zero tibiofemoral angle by ______ (age)
18-24 months
Knees gradually drift into valgus and is maximal around ____ (age) with average medial tibiofemoral angle of ____ degrees
3-4 yrs
12 degrees
Genu valgum spontaneously corrects by age ___ to adult alignment of lower limbs
7 yrs
__ of valgum in females and ___ in males (degrees)
8, 7
Hip Dysplasia Risk Factors
females > males Breech position Family history Low levels of amniotic fluid Swaddling infant too tight
Hip dysplasia clinical exam (5)
Ortolani test Barlow test Klisic sign Galeazzi sign Limited hip abduction
Hip dysplasia tx
1) Pavlik harness is gold standard- Maintains hip in flexion and abduction to keep head of femur in acetabulum (newborn-6mo)
2) Closed reduction under anesthesia followed by SPICA cast for 12 weeks for children 6 mo-2 yrs
3) Open reduction under anesthesia followed by spica cas 6-12 wks for children >2yrs
Transient synovitis- what is it? What are s/sx?
Acute onset of hip pain children 3-10 yrs old, transient inflammation of synovium of hip
1) U/L hip/groin pain 2) med thigh/knee pain 3) crying at night 4) antalgic limp 5) pain not common 6) recent upper respiratory tract infection
Lasts 7-10 days
What is legg-calve perthes disease? Age/male vs female?
Interruption of blood supply to femoral head
2-13 yo, 4x greater incidence males > females
Dx test and result for legg-calve perthes disease
MRI showing positiv bony crescent sign
Clinical exam findings for legg-calve perthes disease and tx
- Characteristic psoatic limp due to psoas weakness, moves in ER/flexion/adduction
- Gradual onset hip/thigh/knee aching
- AROM limited in abduction and extension
Tx: cast 4-6 weeks, surgery if necessary
SCFE - what is it, how old, male vs female, limitations seen
fem head displaced posterior/inferior Males 10-17 yo, females 8-15 yo Males 2x > females AROM limited flexion, abduction, IR vague hip/thigh/knee pain (maybe trendelenburg gait) Requires ORIF
Tendon lengthening conditions
Osgood-schlatter disease
Sever’s disease
Sinding-Larsen Johannson’s disease
What is Sinding-Larsen Johannson’s Disease
Traction apophysitis at patella-patellar tendon junction
Osteochondritis dessicans
Separation of articular cartilage from underlying bone (usually medial femoral condyle)
-Osteochondral bone fragment becomes detached from articular surface forming loose bod in joint
Panner’s disease
Localized AVN of capitellum leading to loss of subchondral bone with fissuring and softening of articular surfaces of radiocapitellar joint (children 10 and younger)
Pes planus (flat foot) Normal in infant and toddler feet and develop normal arches around \_\_\_\_ (age)
2-3 years
Pes planus leads to decreased ability of foot to provide _____ ____ for push off during gait
Rigid lever
Structural vs non-structural scoliosis
Structural: irreversible lateral curve with rotational component
Non-structural: reversible lateral curve without rotational component and straightens with flexion of spine
Tx for scoliosis (conservative, bracing, surgery)
Conservative: <25 degree curve
Bracing: 25-45 degree curve
Surgery with Harrington rod: >45 degree curve
Scoliosis direction named for (convex/concave)
CONCAVITY
Arthrogryposis multiplex congenita
Congenital deformity of skeleton and soft tissues, characterized by limitation in joint motion and “sausage like” appearance of limbs
- Non-progressive contractures
- Intelligence develops normally
OI inherited disorder transmitted by
Autosomal dominant gene
What is OI
- Abnormal collagen synthesis — imbalance between bone deposition and reabsorption
- Cortical and cancellous bones become very thin —> fractures/deformity
Spondylolisthesis
Congenitally defective pars interarticularis
Anterior or posterior slippage of one vertebra on another following bilateral fx of pars
Spondylolysthesis grades
1 (25% slippage) to 4 (100% slippage)
Spondylolysis
Fx of pars with positive “Scotty dog” on oblique x-ray of spine
